Nutritional Status Assessment of the Critically Ill Patient
Published on the 10 July 2018
Published on the 10 July 2018
Malnutrition is associated with an impaired immunologic function, and malnourished patients have poorer outcomes after medical treatment or surgery (Leonard 2009).
Early nutritional support should, therefore, be assessed as soon as possible, preferably upon admission, with ongoing monitoring for all critically ill patients to ensure individual needs are identified and catered for to improve outcomes (Singer & Webb 2005).
The aim of assessing a patient’s nutritional status is to:
The most common factors that can affect nutritional status in critically ill patients include:
All patients should undergo nutritional screening on admission to hospital or healthcare settings (NICE 2006). You should follow your local policies and protocols to identify patients at risk of malnutrition and dehydration.
The screening process categorises patients into groups and those at ‘risk patients’.
A nutritional care plan should be developed, and referral for nutritional support made to an expert/dietitian for more detailed assessment (Kondrup et al. 2003a).
The most widely used screening tool is the malnutrition universal screening tool (MUST)(Russell and Elia 2011). ‘MUST’ is a screening tool used in hospitals, communities and other healthcare settings. It’s a tool used to identify adults who are malnourished, at risk of malnutrition, or obese and it includes management guidelines that can be used to develop a care plan. (Malnutrition Advisory Group 2004).
A full examination of nutritional, metabolic and functional variables should be conducted, and consideration paid to patient history, current medication, laboratory results and patients’ ability to swallow and bowel function.
The assessment should provide information leading to an appropriate care plan (Mallet 2013).
The effectiveness of the nutritional intervention should regularly be monitored, leading to adjustments in treatment as necessary throughout the patient’s stay.
Screening and assessment results and the developed nutritional care plan should be communicated to other health professionals when the patient is transferred somewhere else.
Oral nutrition is generally considered the first line method, but patients who cannot tolerate oral feeding can be fed enterally or parenterally. The route used will depend on:
Enteral feeding is feeding patients liquid feed via a tube placed in the stomach or post-pyloric and is a route of choice for critically ill patients where oral feeding is not possible. This method is used if a patient has a functional and accessible GI tract (NICE 2006).
Parenteral nutrition involves the intravenous infusion of nutrients. It is administrated via a single dedicated lumen either peripherally, via a PICC line, or centrally, via a CVP line.
This route is used when oral and or enteral nutrition is unable to fully meet the patient’s nutritional requirements or when enteral nutrition is contraindicated (Ziegler 2009).
Nutritional status should be assessed and regularly monitored in all critically ill patients. The method of nutritional support should also be closely monitored, in particular, the patients’ tolerance of it.
Lydia Nabwami is registered nurse who has worked in various healthcare settings including cardiac ward, cardiac critical care unit (ITU), general ITU, A&E department, nursing homes and community nursing. She uses her experience as a RN to write well-researched content that helps to attract and motivate audiences. Lydia is also a freelance writer for hire with specialisation in health writing and has helped numerous companies with their content needs. Her work has appeared on sites such as Caring Village, Reachout, Lisa Nelson RD and more. When she isn’t writing, you can find her listening to motivational speeches, keeping active or playing with her two daughters. Contact Lydia or visit her website at Lnwritingservices.co.uk for more information on her services.